Mediation Sports subscription | Vrije Universiteit Brussel

Last Name *

First Name *

Gender *

Male

Female

I'm a student at the *

VUB

Field of Study & year *

Student Number *

Address *

Bank account number (IBAN) *

E-mail *

Cellphone number *

Type Of Subscription *

Membership sportsclub

Turn-up card (at least 10 lessons)

Other

Which Sport is the subscription for? *

Where you a member of this club previously? *

Yes

In which year?

Paid Amount *

Date of Payment *

Upload a copy of your membership card/proof of payment *

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1 + 5 =

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